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Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

  • Richard E. Nelson
    Correspondence
    Corresponding author at: 500 Foothill Blvd, 182, Salt Lake City, UT, 84148, USA. Tel.: +1 801 582 1565x4049.
    Affiliations
    Veterans Affairs Salt Lake City Health Care System, USA

    University of Utah Department of Internal Medicine, Salt Lake City, UT, USA
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  • Scott D. Grosse
    Affiliations
    National Center on Birth Defects and Developmental Disabilities, Office of the Director, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • Norman J. Waitzman
    Affiliations
    University of Utah Department of Economics, Salt Lake City, UT, USA
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  • Author Footnotes
    1 Dr. Lin is currently affiliated with Amgen Inc. At the time of this analysis, Dr. Lin was affiliated with the Veterans Affairs Salt Lake City Health Care System and the University of Utah Department of Pharmacotherapy.
    Junji Lin
    Footnotes
    1 Dr. Lin is currently affiliated with Amgen Inc. At the time of this analysis, Dr. Lin was affiliated with the Veterans Affairs Salt Lake City Health Care System and the University of Utah Department of Pharmacotherapy.
    Affiliations
    Veterans Affairs Salt Lake City Health Care System, USA

    University of Utah Department of Pharmacotherapy, Salt Lake City, UT, USA
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  • Scott L. DuVall
    Affiliations
    Veterans Affairs Salt Lake City Health Care System, USA

    University of Utah Department of Internal Medicine, Salt Lake City, UT, USA

    University of Utah Department of Pharmacotherapy, Salt Lake City, UT, USA
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  • Olga Patterson
    Affiliations
    Veterans Affairs Salt Lake City Health Care System, USA

    University of Utah Department of Internal Medicine, Salt Lake City, UT, USA
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  • James Tsai
    Affiliations
    Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • Nimia Reyes
    Affiliations
    National Center on Birth Defects and Developmental Disabilities, Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • Author Footnotes
    1 Dr. Lin is currently affiliated with Amgen Inc. At the time of this analysis, Dr. Lin was affiliated with the Veterans Affairs Salt Lake City Health Care System and the University of Utah Department of Pharmacotherapy.

      Highlights

      • ~40% of possible pre-discharge VTEs based on ICD-9 codes classified as not probable.
      • NLP was used on outpatient clinical notes to assess VTEs with no VA readmission.
      • Just 21-23% of possible outpatient VTE diagnosed classified as probable based on NLP.
      • Probable VTEs < 90 days of surgery in 1.3% of VA patients, majority after discharge.

      Abstract

      Background

      There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005–2010.

      Methods

      We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes.

      Results

      Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events.

      Conclusion

      More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events.

      Keywords

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